Blood, Vol. 92 No. 9 (November 1), 1998:
pp. 3115-3122
Relationship Between Cleaved L-Selectin Levels and the Outcome of
Acute Myeloid Leukemia
M. Extermann,
M. Bacchi,
N. Monai,
M. Fopp,
M. Fey,
A. Tichelli,
M. Schapira, and
O. Spertini for the Swiss Group for Clinical Cancer
Research (SAKK)
From the Division of Hematology, Centre Hospitalier Universitaire
Vaudois, Lausanne; SIAK Coordinating Center, Bern; Swiss Red Cross
Blood Center, Kantonsspital, St Gallen; Institute of Medical Oncology,
Inselspital and University of Bern, Bern; and the Division
of Hematology, University Hospital, Basel, Switzerland.
High plasma levels of the shed form of L-selectin (sL-selectin) are
frequently detectable in acute myeloid leukemia (AML). sL-selectin can
inhibit blast cell adhesion to vascular endothelium and may thereby
influence the phenotype of AML. In this study, we have investigated the
relationship between sL-selectin levels and clinical presentation or
disease outcome in 100 patients with AML. Fifty-eight patients were
found to have sL-selectin levels 
3.12 µg/mL (3 SD above the
mean of healthy controls: "increased"). Patients with
extramedullary disease such as lymphadenopathies, splenomegaly,
hepatomegaly, and/or muco-cutaneous infiltration had
significantly increased sL-selectin levels (P < .001).
sL-selectin levels were significantly heterogeneous in the
French-American-British subtypes (P = .0003). Patients with
"normal" sL-selectin levels had higher probability of achieving
complete remission (CR) than with "increased" levels: 81% versus
64%, respectively (P = .06). When adjusting for clinically
relevant covariates predictive for CR (sex, age, Auer rods),
"normal" sL-selectin levels were significantly associated with CR
(odds ratio, 3.08; 95% confidence interval [CI], 1.10 to 8.58;
P = .03). Moreover, patients with "increased" sL-selectin levels (3.12 µg/mL) had shorter event-free survival (EFS) (median 7.3 v 12 months, P = .008) and overall
survival (median 1 v 2.05 years, P = .03) than
patients with sL-selectin <3.12 µg/mL. Multivariate statistical
analysis (adjusted for age and presence of Auer rods) indicated that
sL-selectin was an independent prognostic factor for EFS (hazard ratio
[HR], 1.96; 95% CI, 1.21 to 3.17, P = .006) and overall
survival (HR, 1.80; 95% CI, 1.09 to 2.98; P = .02). Thus,
plasma sL-selectin may be a useful prognostic marker in the evaluation
of AML at diagnosis.
© 1998 by The American Society of Hematology.
